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A Chance for Girls: How Public Health Improvements Increase Educational Opportunities

Having a period shouldn’t prevent anyone from going to school, but in some places it does. Vital interviewed Fiona Almeida, who founded a program to provide reusable sanitary pads to girls in rural India so that they can attend school.

It’s common for menstruation to be a taboo topic in many cultures, but the fact that it is considered unusual, embarrassing, or negative has serious consequences for girls and women across the globe.

For a long time, scientists and researchers have tended to see certain kinds of bodies as normal, and, as we’ve noted before, these bodies are usually male and of European descent. This focus is thankfully widening to include a larger population, but more work needs to be done. As Wellesley College president Paula Johnson pointed out in her TED talk on the unique ways heart attacks present in women, assuming that research on men automatically describes the experience of women is an approach with dire consequences.

Perhaps people have tended to ignore the needs of menstruating women because menstruation is seen as some kind of abnormality—if male bodies are considered “normal,” then the female reproductive system and its regular, healthy processes seem abnormal, or, at best, unusual. They are not.

In the United States, legislatures have begun to recognize menstrual products as a basic need by removing taxes on them and making them more widely available. In the summer of 2016, New York state, as Jennifer Weiss-Wolf writes in the New York Times, passed “the nation’s first legislative package to ensure access to menstrual products in public schools, shelters and corrections facilities.”

There are other places in the world where the stigma associated with menstruation is so strong that it actually prevents girls from attending school. Fiona Jamal Almeida, a Public Policy student at Tufts University, has spent the last several summers working with girls in rural India. Vital interviewed her to find out more about how she’s helping girls get an education through public health improvements.

Could you tell us a bit about your work?

I was born and raised in South Africa and have a passion for interdisciplinary approaches to address global development and women’s reproductive health concerns. For the past four years, I have been conducting field research in Karnataka, India. My research focuses on a minority group of African Indians called Siddis, living in the most remote areas of Karnataka. Together with the community, I have implemented two ongoing projects in several Siddi villages in Karnataka. I taught women the skill of making reusable cotton sanitary pads and in 2016, I implemented an awareness and prevention project called Break Free From Depression for Adolescents. The projects in India are part of my ongoing interest in and commitment to education access and women’s reproductive health.

Could you tell us a bit about the population of girls that you were working with in rural India?

Sure. In rural Karnataka, India, lives a marginalized group of African Indians, whose ancestors were brought to India as enslaved people over 600 years ago. They are known as Siddis and belong to one of the lowest castes in India called “Scheduled Tribes” (STs). STs are communities of people considered to be marginalized indigenous groups in India. The Siddis are isolated from the larger society and are discriminated against due to their physical appearance and darker skin color. Siddis lack access to basic resources such as clean water, formal education, healthcare, and sanitation. Many young girls and women face a myriad of challenges regarding their reproductive health and education due to poverty and cultural gender biases.

I had the opportunity to conduct fieldwork and live among Siddis in Karnataka, in particular with young girls at rural hostels. Many of these young girls live in abject poverty; some are orphans, survivors of child bride practices, human trafficking, and physical sexual assault.

During my interviews, I learned that young girls are absent for fifty or more days throughout the school year and teachers will miss four to five days of work per month because of menstruation. Some NGOs (nonprofit government organizations) are working with local Indian government officials to promote reusable sanitary pads, but their availability has not reached Siddi women and girls who remain at a disadvantage because of their minority status as STs.

How did you discover that girls were prevented from going to school in this region?

While staying in the village, I spent most of my days with the young Siddi girls from the hostels. At first glance, I noticed a pattern that, at any given time, three or four adolescent girls would not attend school and complain of stomach cramps. After 2 weeks, I became curious and wondered if they had food poisoning. So I decided to ask the sisters from the convent what might be giving the girl’s stomach cramps? I was told that the girls were going to be fine and that they did not want to attend school, therefore they complained of stomach cramps. The pattern continued and more adolescent girls stayed behind and missed school. At this point, they were missing between three to five days of school every month. I became very fond of all the girls in the hostel and recognized that they had a drive for learning and that it was not normal for them to remain at the hostel with stomach cramps. By the third week of this same behavior, I inquired once more and this is when I learned the truth about why Siddi girls were not attending school. The sisters disclosed that when a young girl has her period they do not attend school, especially in rural areas, because girls were considered impure or dirty; male classmates and teachers would tease girls if they experienced leakage; cultural taboos kept girls isolated; there were no functioning toilets; and Siddi girls did not have proper sanitary pads.

What did you learn about cultural assumptions and their impact on girls’ education?

My interactions with the Siddi girls educated me about their concerns surrounding puberty and menstruation. For example, some castes in India pathologize this biological phenomenon to make young girls and women feel that they have a disease. Further, parents or caregivers feel powerless at helping their children during this process because they, themselves, are not well equipped with the necessary knowledge about menstruation. The girls also disclosed to me that they do not have access to or cannot afford sanitary pads.

What plan did you create to help the girls?

During the summer of 2013, I had the opportunity to collaborate with young Siddi girls and women in order to learn how reproductive health is regarded within their community in Karnataka, India. My interactions with them helped me understand some of the challenges they face because of the cultural stigma attached to menstruation and their limited understanding about puberty and reproductive health.

Armed with this information, I sought to supply sanitary pads–made with cotton fabric that can be washed and reused–to Siddi girls and women and to educate them about puberty and menstruation. Another component of the project was to recruit and train Siddi girls and women to learn how to sew and market the reusable pads as a sustainable small business enterprise. These efforts will help the girls enhance their future financial independence while contributing to their development and to that of their communities. I also began to work with young men who became interested in the project. I educated them about women’s reproductive health. In fact, some of the young men have now been conducting information sessions for other village people. By exposing the men to how taboos and other practices exclude and negatively impact girls and women, these young men, I hope, will help break the cycle of repression that adversely impacts women.

Do you have thoughts about how this work might change the culture that marginalizes women and stigmatizes female reproductive health?

I am working to establish a way for individuals to understand one another without judgment and to be mindful of others and their circumstances. The reusable cotton sanitary pad is the beginning of a new effort for the young Siddi girls and women to start taking charge of their bodies. When women take charge of their bodies, they can feel confident and make decisions that will improve their quality of life and that of others in their communities. While working with the Siddi community, I was also able to extend the program to other girls and women facing similar marginalization by promoting the use of reusable sanitary pads and educating them on women’s reproductive health. When we extended the program, the Siddi women and I found that many women experience similar types of marginalization. This was a start to opening up dialogue and creating a space where there was cultural exchange between different castes and tribes. Many of the villagers do not necessarily gather with other villagers due to their perceived caste and tribal differences, so I found these new occasions for dialogue incredible.

Ultimately, the reusable cotton sanitary pads served as a catalyst. They have enabled young women and female teachers to stay in school more days out of the year. They brought together groups of women from different castes and tribes for a discussion about their bodies. Discussing their bodies has helped women build self-confidence as well as self-awareness, creating respect for one another and forming a network of support, which, in turn, will foster peace across castes and tribal differences.

For me, personally, this experience was challenging but also fruitful. I lived with the community I was working with and shared in their life experiences. I spent days with a lack of electricity, running water, and other amenities that I am used to. I enjoyed religious celebrations and festivals. In the evenings, I tutored the young girls in English and immersed myself in their culture by having conversations with locals, and interacting with them on their farmlands. I was able to see first-hand some of the hardships that these communities face. I was amazed to witness, though, that despite these difficulties, they are incredibly kind and hospitable to everyone in their communities.

Fiona Almeida is a native of South Africa who now lives in Cambridge, Massachusetts. Currently a masters student focusing on Urban Environment Policy and Planning at Tufts University School of Public Policy, Almeida is passionate about global healthcare and education. In the summer of 2017, she plans to return to India, where she will focus her research on cultural identity and migration among the Siddi population.